PEDIATRIC CCRN PRACTICE EXAM 2026
QUESTIONS WITH VERIFIED CORRECT
ANSWERS
◉ Tumor Lysis syndrome most common causes. Answer: AML, ALL,
post initial chemo for solid tumors, high grade lymphoma
◉ Management of tumor lysis syndrome. Answer: • Identify patients
at risk.
• 2x maintenance hydration therapy to maximie K, phos & uric acid
excretion
• Prevent uric acid with allopurinol
- Tx uric acid with rasburicase
• Use IV sodium bicarbonate to counter effects of acidic properties
that are released.
EKG for hyperkalemia
urine pH goal 7-8
Limit K/phos
◉ hyperleukocytosis. Answer: increased peripheral WBC
(peripheral leukocytes>100,000) leading to capillary obstruction,
microinfarction, organ dysfunction
common in ALL, AML, ANLL
,◉ hyperleukocytosis tx. Answer: decrease leukocyte ct, avoid PRBCS
to limit increased blood viscosity, CHEMO, leukapheresis/exhange,
prevent TLS
◉ Sickle Cell Disease triggers. Answer: Dehydration
Infections
Stress, hypoxia
Cold
◉ normal platelet count. Answer: 150,000-400,000
◉ normal fibrinogen count. Answer: 200-400
◉ shift to the right WBCs. Answer: increase in neutraphils mature
◉ shift to the left. Answer: incrase in immature neutrophils
◉ ANC counts. Answer: < 1500 but > 1000 mm3 is mild.
< 1000 but > 500 mm3 is moderate.
, < 500 mm3 is severe.
◉ s/s of TLS. Answer: numbness, cardiac dysrhythmia, renal failure
◉ pre-renal AKI causes. Answer: obstruction, volume depletion,
impaired cardiac function
◉ pre-renal AKI compensatory mechanisms. Answer: alteration in
extrarenal: CO, systemic vascular tone, ADH, systemic blood flow,
systemic BP, think about PEEP
◉ s/s of pre-renal AKI. Answer: oliguria at first
ACid base changes secondary to decreased RBF
Azotemia(increased uremia & nitrogen)
increased BUN, Cr, Urine spec grav
TX: d/c K, avoid nephrotoxic agent, diuretics if caught early, volume
◉ Intrinsic AKI causes. Answer: -Structural kidney damage due to....
-vascular damage(HUS, TTP, DIC)
-glomerular damage (lupus, drugs)
-Acute tubular necrosis
QUESTIONS WITH VERIFIED CORRECT
ANSWERS
◉ Tumor Lysis syndrome most common causes. Answer: AML, ALL,
post initial chemo for solid tumors, high grade lymphoma
◉ Management of tumor lysis syndrome. Answer: • Identify patients
at risk.
• 2x maintenance hydration therapy to maximie K, phos & uric acid
excretion
• Prevent uric acid with allopurinol
- Tx uric acid with rasburicase
• Use IV sodium bicarbonate to counter effects of acidic properties
that are released.
EKG for hyperkalemia
urine pH goal 7-8
Limit K/phos
◉ hyperleukocytosis. Answer: increased peripheral WBC
(peripheral leukocytes>100,000) leading to capillary obstruction,
microinfarction, organ dysfunction
common in ALL, AML, ANLL
,◉ hyperleukocytosis tx. Answer: decrease leukocyte ct, avoid PRBCS
to limit increased blood viscosity, CHEMO, leukapheresis/exhange,
prevent TLS
◉ Sickle Cell Disease triggers. Answer: Dehydration
Infections
Stress, hypoxia
Cold
◉ normal platelet count. Answer: 150,000-400,000
◉ normal fibrinogen count. Answer: 200-400
◉ shift to the right WBCs. Answer: increase in neutraphils mature
◉ shift to the left. Answer: incrase in immature neutrophils
◉ ANC counts. Answer: < 1500 but > 1000 mm3 is mild.
< 1000 but > 500 mm3 is moderate.
, < 500 mm3 is severe.
◉ s/s of TLS. Answer: numbness, cardiac dysrhythmia, renal failure
◉ pre-renal AKI causes. Answer: obstruction, volume depletion,
impaired cardiac function
◉ pre-renal AKI compensatory mechanisms. Answer: alteration in
extrarenal: CO, systemic vascular tone, ADH, systemic blood flow,
systemic BP, think about PEEP
◉ s/s of pre-renal AKI. Answer: oliguria at first
ACid base changes secondary to decreased RBF
Azotemia(increased uremia & nitrogen)
increased BUN, Cr, Urine spec grav
TX: d/c K, avoid nephrotoxic agent, diuretics if caught early, volume
◉ Intrinsic AKI causes. Answer: -Structural kidney damage due to....
-vascular damage(HUS, TTP, DIC)
-glomerular damage (lupus, drugs)
-Acute tubular necrosis
